title: Comparison of intra-aortic computed tomography angiography to conventional angiography in the presurgical visualization of the Adamkiewicz artery: first results in patients with thoracoabdominal aortic aneurysms.
abstract: BACKGROUND
  The aim of this study was to compare the sensitivity of intra-aortic computed tomography angiography (IA-CTA) to that of regular spinal digital subtraction angiography for the presurgical location of the Adamkiewicz artery (AKA).
  
  
  METHODS
  Thirty patients (21 males, 9 females; mean age 64 years) had an IA-CTA for the location of the AKA before surgery of aneurysm (n = 24) or dissection (n = 6) of the thoracoabdominal aorta. After femoral artery puncture, a pigtail catheter was positioned at the origin of the descending aorta. CT acquisition was performed with an intra-aortic iodinated contrast media injection (15 mL/s, 120 mL). The visualization of the AKA and the location of the feeder(s) to the AKA were independently evaluated by two observers. Interrater agreement was calculated using a kappa test. Spinal angiogram by selective catheterization was systematically performed to confirm the results of the IA-CTA.
  
  
  RESULTS
  The AKA was visualized by the IA-CTA in 27/30 cases (90 %); in 26/31 (84 %) cases, the continuity with the aorta was satisfactorily seen. Interrater agreement was good for the visualization of the AKA and its feeder(s): 0.625 and 0.87, respectively. In 75 % of the cases for which the AKA was visualized, the selective catheterization confirmed the results of the IA-CTA. In the remaining 25 % of the cases, the selective catheterization could not be performed due to marked vessels' tortuosity or ostium stenosis.
  
  
  CONCLUSIONS
  IA-CTA is a feasible technique in a daily practice that presents a good sensitivity for the location of the AKA.
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France, fredclare5@msn.com.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.forename: Evelyne
authors.initials: E
authors.lastname: Cormier
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
authors.forename: Nader
authors.initials: N
authors.lastname: Sourour
authors.forename: Joseph
authors.initials: J
authors.lastname: Gabrieli
authors.forename: Christina
authors.initials: C
authors.lastname: Iosif
authors.forename: Catherine
authors.initials: C
authors.lastname: Jenny
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*